Sarcopenia !

Sarcopenia is the age-related loss of muscle strength and mass. It slows walking, causes falls and is a core part of frailty in older adults.

Updated 2026-11-01

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Why it happens

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What it is

A progressive and generalised skeletal muscle disorder in which low muscle strength, together with low muscle quantity or quality, increases the risk of falls, fractures, disability and death. The European EWGSOP2 consensus puts low strength first as the key feature.

Who gets it

Common in older adults, more so after 75, in hospital patients and in care homes; estimates vary widely with the definition used. Latin American population studies on ageing, such as the SABE surveys (including Colombia), describe a high burden of weakness, slow gait and frailty in older adults, linked to poverty, poor nutrition and chronic disease.

Causes

Primary (age-related): loss of motor neurons and fast muscle fibres with ageing
Physical inactivity, bed rest and immobility
Low intake of energy and protein, malnutrition and malabsorption
Chronic diseases: heart failure, COPD, chronic kidney disease, diabetes, cancer and inflammatory diseases
Hormonal changes: lower testosterone, growth hormone and vitamin D

Risk factors

Older age
Sedentary life or recent hospitalisation
Low protein intake and weight loss
Obesity (sarcopenic obesity) and insulin resistance
Smoking and chronic inflammation
Multimorbidity and long-term glucocorticoid use

Pathophysiology

With age, muscle protein synthesis responds less to food and exercise (anabolic resistance), motor units are lost and fast type II fibres shrink. Fat infiltrates the muscle, lowering its quality, while chronic low-grade inflammation and inactivity accelerate breakdown. Strength falls faster than mass, which is why function and strength are measured first.

Classification

Probable sarcopenia: low muscle strength
Confirmed sarcopenia: low strength plus low muscle quantity or quality
Severe sarcopenia: low strength, low muscle mass and low physical performance
Primary (age-related) or secondary (to disease, inactivity or malnutrition); acute or chronic

Symptoms and signs

Weakness and trouble rising from a chair or climbing stairs
Slow walking and fatigue
Falls and loss of balance
Thinner arms and legs, sometimes hidden by excess fat
Difficulty carrying bags, opening jars or with daily activities

Diagnosis

Clinical: EWGSOP2 path (find, assess, confirm, severity): case finding with the SARC-F questionnaire or clinical suspicion (falls, slowness, weakness); strength measured with handgrip dynamometry or the five-times chair stand test; physical performance with gait speed, the Short Physical Performance Battery (SPPB) or the Timed Up and Go test. Calf circumference is a simple field measure of muscle mass.
Tests: Blood tests look for causes and contributors: blood count, albumin, kidney and liver function, glucose, thyroid function, vitamin D and, when relevant, testosterone, inflammatory markers and creatine kinase.
Imaging: Muscle quantity is confirmed with DXA (appendicular lean mass) or bioelectrical impedance in routine care; CT, MRI and muscle ultrasound are used in research or specialised settings.

Differential diagnosis

Cachexia from cancer, heart failure or other chronic disease
Malnutrition without primary muscle disease
Myopathies (inflammatory, drug-induced such as statins or glucocorticoids, endocrine)
Neurological disease: Parkinson disease, neuropathy, motor neuron disease
Hypothyroidism and depression

Goal of treatment

Recover or preserve muscle strength and function, prevent falls and disability, and treat the conditions that drive muscle loss.

Treatment

Rehabilitation: Progressive resistance (strength) training is the core treatment, combined with balance and aerobic exercise and supervised by physiotherapy when possible.
Lifestyle: Adequate energy and protein intake spread through the day, with nutritional supplements when intake is low; vitamin D correction if deficient.
Medical: Treatment of the underlying diseases and review of medicines that cause weakness or falls; no drug is approved specifically for sarcopenia.
Follow-up: Repeat grip strength, gait speed and weight over time; fall-risk assessment and bone health assessment.

Complications

Falls and hip and other fragility fractures
Loss of independence in daily activities
Frailty and institutionalisation
Longer hospital stays, more complications after surgery and higher mortality
Swallowing and breathing muscle weakness in severe cases

Prognosis

Sarcopenia predicts disability, hospital admission and death, but it is partly reversible: resistance training with good protein intake improves strength and function even in very old adults.

Prevention

Regular physical activity with strength exercises throughout adult life
Sufficient protein and energy intake in older age
Avoiding unnecessary bed rest during hospital stays

Test yourself

Think of the answer, then tap the question to see it.

According to EWGSOP2, which feature is the main criterion for probable sarcopenia?

Low muscle strength, measured with handgrip dynamometry or the chair stand test.

Which questionnaire is used for case finding of sarcopenia?

The SARC-F, a five-item questionnaire about strength, walking, rising from a chair, climbing stairs and falls.

Which test is the usual way to confirm low muscle mass in routine practice?

Dual-energy X-ray absorptiometry (DXA), or bioelectrical impedance analysis; CT and MRI are reference methods mainly in research.

How is severe sarcopenia defined?

Low strength plus low muscle quantity or quality plus low physical performance, such as slow gait speed or a low SPPB score.

What is the main treatment of sarcopenia?

Progressive resistance exercise together with adequate protein and energy intake.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Sarcopenia: revised European consensus on definition and diagnosis (Age and Ageing, 2019).

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